Does knowledge of predictors of recovery and nonrecovery assist outcomes after whiplash?

Sterling, Michele M. (2011) Does knowledge of predictors of recovery and nonrecovery assist outcomes after whiplash?. Spine, 36 25 Supp.1: S257-S262. doi:10.1097/BRS.0b013e31823881bc


Author Sterling, Michele M.
Title Does knowledge of predictors of recovery and nonrecovery assist outcomes after whiplash?
Journal name Spine   Check publisher's open access policy
ISSN 0362-2436
1528-1159
Publication date 2011-12-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/BRS.0b013e31823881bc
Open Access Status Not yet assessed
Volume 36
Issue 25 Supp.1
Start page S257
End page S262
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Nonsystematic review.

Review of prognostic indicators for outcome after whiplash injury and the implications for clinical practice and future research.

The capacity to predict outcome after whiplash injury is important to guide the management of the condition. There have now been numerous cohort studies and several systematic reviews of prognosis. It is not clear if the current knowledge of prognostic indicators is useful for clinical practice and to improve outcomes after injury.

Nonsystematic review of research investigating the prediction of chronic pain/disability and psychological outcomes after whiplash injury.

There remains considerable uncertainty surrounding the identification of clear prognostic indicators after whiplash injury. All systematic reviews note the moderate or lower quality if primary cohort studies and only one systematic review performed meta-analysis. There have been no studies attempting validation of predictive models. At the present time, the knowledge base stands that higher initial pain levels are the most consistent predictor of poor functional recovery. Additional promising factors include physical factors of cold hyperalgesia and loss of neck range of movement, although the latter is inconsistent. Psychological factors of pain catastrophizing, symptoms of post-traumatic stress and recovery perceptions are also prognostic of poor recovery and the presence of depressed mood is inconsistent. Further research is needed to validate predictive models, investigate interactions between factors, and to determine whether modification of predictors is possible and leads to improved outcomes.

The understanding of factors predictive of poor recovery after whiplash injury is evolving. Although more research is required to validate predictive models, some factors show consistent predictive capacity and could be used in clinical practice as potential indicators of poor recovery. It is not known if the specific targeting of modifiable prognostic indicators can be achieved or will lead to improved outcomes.
Formatted abstract
Study Design.
Nonsystematic review.

Objective.
Review of prognostic indicators for outcome after whiplash injury and the implications for clinical practice and future research.

Summary of Background Data.
The capacity to predict outcome after whiplash injury is important to guide the management of the condition. There have now been numerous cohort studies and several systematic reviews of prognosis. It is not clear if the current knowledge of prognostic indicators is useful for clinical practice and to improve outcomes after injury.

Methods.
Nonsystematic review of research investigating the prediction of chronic pain/disability and psychological outcomes after whiplash injury.

Results.
There remains considerable uncertainty surrounding the identification of clear prognostic indicators after whiplash injury. All systematic reviews note the moderate or lower quality if primary cohort studies and only one systematic review performed meta-analysis. There have been no studies attempting validation of predictive models. At the present time, the knowledge base stands that higher initial pain levels are the most consistent predictor of poor functional recovery. Additional promising factors include physical factors of cold hyperalgesia and loss of neck range of movement, although the latter is inconsistent. Psychological factors of pain catastrophizing, symptoms of post-traumatic stress and recovery perceptions are also prognostic of poor recovery and the presence of depressed mood is inconsistent. Further research is needed to validate predictive models, investigate interactions between factors, and to determine whether modification of predictors is possible and leads to improved outcomes.

Conclusion.  The understanding of factors predictive of poor recovery after whiplash injury is evolving. Although more research is required to validate predictive models, some factors show consistent predictive capacity and could be used in clinical practice as potential indicators of poor recovery. It is not known if the specific targeting of modifiable prognostic indicators can be achieved or will lead to improved outcomes.
Keyword Whiplash
Outcome
Prediction
Prognostic-factors
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes "Focus Papers: Prediction of Outcome"

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 13 Dec 2011, 23:06:19 EST by Chesne McGrath on behalf of Medicine - Royal Brisbane and Women's Hospital